ARA

Pregnancy

Alcohol & Pregnancy

There is conclusive scientific evidence that certain patterns of drinking during pregnancy can be harmful to the unborn child (Florey 1992). These patterns include heavy chronic and episodic consumption.

However, there is less agreement on the risks of low levels of drinking by pregnant women. Knowledge is not sufficiently advanced to determine precisely the threshold beyond which alcohol causes damage (Baer 2003; Day 2002). Therefore it is advisable to err on the side of caution.

A cluster of genetic and congenital anomalies, classed as Foetal Alcohol Syndrome (FAS) has been found in some children born to women who are either dependant on or abuse alcohol.

The anomalies include pre- and post-natal growth deficiency, distinctive facial features and central nervous system dysfunction. However not all women who are alcohol dependant or abuse alcohol give birth to children with FAS.

What has been shown is that patterns of alcohol consumption (Croxford and Viljoen 1999) and a multitude of other factors (Viljoen 2001) can exaggerate the manifestations of FAS. These factors include poor maternal health, poor diet, older age, smoking and illicit drug use, and a problematic past obstetric history.

Overall higher rates of FAS have been reported among populations with low socioeconomic status and among marginalised groups (Abel 1995).

In an effort to educate the public, governments, quasi-governmental organisations and professional bodies in a number of countries have issued specific recommendations around drinking during pregnancy. In general, there is strong consensus that women should either abstain from or only drink low amounts of alcohol during pregnancy.

Until information is more precise in this area, women who are pregnant or expecting to be pregnant should take special care about their drinking (Menella 2001). They should preferably not drink without having sought advice from their doctor on the issue.

The ARA believes that much research still needs to be done (Floyd et al 1999) to determine the contribution the multitude of factors, including alcohol, makes towards the defects characterising FAS.

For this reason, it facilitated the establishment of the Foundation for Alcohol Related Research (FARR) in August 1996. ARA continues to support FARR in its pioneering research in this field by funding the administrative costs of the Foundation, building local research capacity through its funding of post-graduate research fellowships administered by FARR and establishing a training facility.

These efforts have resulted in partnerships between FARR and research collaborators such as the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the Centres for Disease Control (CDC) in the USA, the National Health Laboratory Services (NHLS) formerly known as the South African Institute for Medical Research (SAIMR) and the South African Medical Research Council.

Conclusion

• There is strong scientific evidence that certain maternal patterns of drinking during pregnancy are associated with substantial risk of physical and psychological harm to offspring. These drinking patterns generally include heavy drinking.
  
• There is currently no consensus on the threshold of maternal drinking below which the risk to the fetus is negligible. As a result, most official guidelines around drinking during pregnancy recommend abstinence or low levels of alcohol consumption.
  
• Until information is more precise in this area than at present, women who are pregnant or expecting to be pregnant should take special care about their drinking and should preferably not drink without having sought advice from their physician.
  
• Harm associate with maternal drinking is preventable and can be successfully addressed through harm reduction approaches to policy and prevention, including education and awareness building.

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